PROJECT SUMMARY/ABSTRACT The University of Washington Urinary Stone Disease Clinical Center (UWCC) seeks to advance the field of urinary stone disease (USD) research through participation in the Research Network and by taking a comprehensive aim at the problem of ureteral stent burden. In the United States, USD affects 1 in 9 adults, exerting a substantial burden related to pain, lost work, and healthcare expenditures that add up to $10 billion per year. The per capita disability from USD in the United States is higher than any other nation, potentially reflecting the cost and side effects of intensive treatment. A team of investigators with broad experience in urology, pediatrics, nephrology, health services, bioinformatics, pharmacogenetics, pain medicine, and biostatistics across the University of Washington, Seattle Children's Hospital, and the VA Puget Sound Health Care System will address this complex problem, harnessing the extensive patient care and research infrastructure of these institutions. The clinical activity of 6 hospitals will be harnessed to provide the platform for sufficient sample sizes to address two main facets of USD. Our specific aims include (1) to determine the effectiveness of a short message service (SMS, or text) reminder-optimized, fluid-intake intervention on kidney stone recurrence in urinary stone formers; (2) to characterize the symptom burden of ureteral stents and to evaluate strategies that reduce ureteral stent-related pain and discomfort; and (3) to identify novel mechanistic candidates associated with stent-related pain and urinary bother. Our interrelated aims set the stage for future USDRN-wide trials to move top study designs and tools into translational applications, including those for disease prevention, drug targeting of severe stent-related problems, and biomarker development. We envision that our proposed strategies will move USD prevention and treatment beyond a trial-and-error approach, informing clinically relevant intervention and prevention decisions at both an individual and a population level.